Provider Demographics
NPI:1326590449
Name:TRICOUNTY TELE BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:TRICOUNTY TELE BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:QADIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-803-4016
Mailing Address - Street 1:101 E MILLER ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2123
Mailing Address - Country:US
Mailing Address - Phone:407-803-4016
Mailing Address - Fax:407-803-4045
Practice Address - Street 1:501 N ORLANDO AVE
Practice Address - Street 2:SUITE 313-185
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-7313
Practice Address - Country:US
Practice Address - Phone:407-803-4016
Practice Address - Fax:407-803-4045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME623882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty